Jeopardy Fellow - 2/3

Malignant Hematology

100

Name the BiTes approved for r/r DLBCL

Epcoritamab and Glofitamab

Epcoritamab - based on EPCORE NHL-1 (DLBCL)

Glofitamab - based on phase 1/2 NP30179, but we usually use the regimen from Starglo trial

200

lymphoma most commonly having t(11;14)

Mantle Cell Lymphoma

t(8;14)(q24;q32): Burkitt's lymphoma

t(14;18)(q32;q21): Mantle zone lymphoma

t(11;14)(q13;q32): follicular lymphoma

t(11;18)(q21;q21): extranodal MALToma

t(2;5)(p23;q35): ALK-positive anaplastic large cell T-cell lymphoma

300

before starting this drug, need to send RBC genotyping

Daratumumab

400

AML mutation confers a favorable prognosis only in the absence of FLT3-ITD

Fav: 

• t(8;21)(q22;q22.1) → RUNX1–RUNX1T1

• inv(16)(p13.1q22) or t(16;16) → CBFB–MYH11

• NPM1 mutation without FLT3-ITD 

• bZIP in-frame mutated CEBPA

Intermediate:

• NPM1 mutation with FLT3-ITD

• Wild-type NPM1 with FLT3-ITD

• t(9;11)(p21.3;q23.3) → KMT2A–MLLT3

• Cytogenetic abnormalities not classified as favorable or adverse

Adverse

Cytogenetics

• Complex karyotype (≥3 abnormalities)

• Monosomal karyotype

• inv(3)(q21q26.2) or t(3;3) → GATA2–MECOM

• t(6;9)(p23;q34.1) → DEK–NUP214

• t(v;11q23.3) other than t(9;11)

• t(9;22) (BCR-ABL1)

• −5 or del(5q)

• −7

• −17 / abn(17p)

Mutations

• TP53

• RUNX1

• ASXL1

• BCOR

• EZH2

• SF3B1
• SRSF2
• STAG2
• U2AF1
• ZRSR2

500

This mutation predicts response to venetoclax in AML due to mitochondrial dependence.

IDH1/2

mutations lead to increased conversion of alpha-ketoglutarate to 2-hydroxyglutarate, which causes inhibition of Cytochrome c oxidase in mitochondria. This inhibition causes mitochondrial dysfunction that mimics a state of oxygen deprivation (hypoxia)  and this stress signal normally activates pro-apoptotic proteins BAX and BAK, which lead to mitochondrial outer membrane permeabilization (MOMP) and cell death. 

To survive this elevated apoptotic pressure, IDH1/2-mutant cells upregulate or become heavily dependent on the anti-apoptotic protein BCL2 to neutralize the activated BAX/BAK.

Because the cells rely on BCL2 to prevent death, inhibiting BCL2 like venetoclax removes this survival signal, allowing BAX/BAK to trigger massive apoptosis.

VIALe trial - Aza Ven vs Aza alone in naive AML

All comers: composite complete response: 66.4% vs 28.3%

IDH1/2 mutated: 75.4% vs 10.7%

FLT3 mutation: 72.4% vs 36.4%

NPM1 mutation: 66.7% vs 23.5%

Tp53 mutation: 55.3% vs 0%

Breast Cancer

100

52 year old female underwent prophylactic complete mastectomy for BRCA1 mutation and pathology of both breast revealed DCIS in left breast 7 mm, <2 mm from the closest margin, ER 80%, PR 70%, grade 2. How long should the adjuvant endocrine treatment be given?

Not required

Adjuvant endocrine therapy is not recommended for ER-positive DCIS after bilateral mastectomy, as there is no residual breast tissue and no demonstrated benefit in recurrence or survival. The primary rationale for adjuvant endocrine therapy in DCIS is to reduce the risk of ipsilateral and contralateral breast events, particularly in patients treated with breast-conserving surgery who retain breast tissue.

200

These PARPis are approved in Breast cancer

Olaparib - Metastatic - Olympiad

Olaparib - Adjuvant - Olympia

Talazoparib - Metastatic - Embraca

300

First line for de novo metastatic TNBC with NGS showing tp53 mutation, PDL1 8%, TMB 7 muts/mb

Single agent chemo - taxane, anthracyclines or platinum

if PDL1 > 10% - pembro can be added or can also use Saci with Pembro

400

58 year old female with BRCA 2 mutation developed early stage HER2 positive breast cancer s/p neoadjuvant systemic treatment, lumpectomy with sentinel node dissection and found to have some residual disease. Plan to start T-DM1. Which PARPi would be recommended for her BRCA mutation for adjuvant treatment?

None

Only approved in HER2 negative breast cancer

500

60 year old female with pT1a grade 1 ER+ HER2- IDC s/p lumpectomy with no sentinel lymph node biopsy. Should the patient receive partial breast RT/Whole breast RT?

Whole breast

Thorax

100

This the target for Telistotuzumab vedotin

c-MET directed ADC >= 25%

200

Neoadjuvant treatment modality in resectable superior sulcus tumor - T3/T4 N0/N1 disease

ChemoRT

SWOG 9416/Intergroup 0160 trial, which demonstrated that induction chemoradiation (cisplatin/etoposide with concurrent 45 Gy radiation) followed by surgery achieved a 5-year overall survival of 44%, with complete resection rates of 92% and pathologic complete response in approximately one-third of patients.

300

In which cancer Masaoka staging used 

Thymoma

400

These are the mutation we look for if a patient is undergoing resection of stage II NSCLC

ALK - Alina Trial - Alectinib

EGFR 21 L858R and 19 del - Adaura Trial - Osimertinib

500

duration of durvalumab maintenance for SCLC after getting concurrent chemoRT

24 months

GU/GI

100

choice of regimen in esophageal adenocarcinoma in perioperative setting

FLOT - based on ESOPEC trial

4 2 weeks cycle pre and post surgery

200

This regimen is standard of care for cis eligible muscle invasive bladder cancer

Cis Gem Durva - Niagara trial 

300

This TKI is used in patients with unresectable/metastatic GIST with PDGFRA exon 18 mutation (D842V)

Avapritinib

400

65 year old male with recently diagnosed prostate cancer, which is invading seminal vesicle and has node enlargement on scan, majority cores showing 4+5, PSA 37 ng/ml. He is not a candidate for surgery. RT is preferred modality of treatment. This additional systemic treatment is necessary?

Abiraterone (2 years) plus ADT (3 years)

500

Perioperative Durva FLOT did not show benefit in this subgroup of gastric and GEJ adenocarcinoma based on histology

Diffuse

Fun Facts

100

Madame Curie discovered this radioactive material and subsequently died from it

Radium, Polonium

200

Frank Baum, born in Chittenango, NY close proximity to Syracuse, wrote this famous book

The Wizard of Oz

300

This famous furniture company, with major outlets now across US, was started in Syracuse

Raymour and Flanigan

Founded in 1947 in Syracuse, New York, by brothers Bernard and Arnold Goldberg, originating from a family-owned jewelry and furniture business. Originally named Raymour’s Furniture, it grew from a single store into the Northeast's largest furniture retailer, expanding through acquisitions like Flanigan’s Furniture in 1990

400

Place in the world where traffic lights are upside down, instead of red yellow green, here they have green yellow red

Intersection of Milton Avenue and Tompkins Street on Tipperary Hill in Syracuse, NY

500

This HemOnc Attending have birthday next week

Dr. Benjamin - 2/12

Happy birthday to Alanna and Sujan